Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TRAY LACERATION STR ER

Facility

$34.00

Hospital Charge Code	22355311
Hospital Revenue Code	270
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.44
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

TRAY LUMBAR ADULT

Facility

$143.00

Hospital Charge Code	22354932
Hospital Revenue Code	270
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Arizona Complete Health Allwell	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.88
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Devoted Health Medicare	$25.74
Rate for Payer: Humana of AZ Medicare	$22.88
Rate for Payer: Southwest Service Administrators UFCW	$97.24
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: United Healthcare Commercial	$81.80
Rate for Payer: United Healthcare Medicare	$22.88
Rate for Payer: Veterans Affairs TRICARE	$22.65

TRAY LUMBAR ADULT

Facility

$143.00

Hospital Charge Code	22354932
Hospital Revenue Code	270
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Cash Price	$114.40

TRAY LUMBAR PED

Facility

$159.00

Hospital Charge Code	22354182
Hospital Revenue Code	270
Min. Negotiated Rate	$25.19
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Arizona Complete Health Allwell	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Devoted Health Medicare	$28.62
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Southwest Service Administrators UFCW	$108.12
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: United Healthcare Commercial	$90.95
Rate for Payer: United Healthcare Medicare	$25.44
Rate for Payer: Veterans Affairs TRICARE	$25.19

TRAY LUMBAR PED

Facility

$159.00

Hospital Charge Code	22354182
Hospital Revenue Code	270
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Cash Price	$127.20

TRAY SPINAL 25G WHITACRE

Facility

$75.00

Hospital Charge Code	22354922
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Cash Price	$60.00

TRAY SPINAL 25G WHITACRE

Facility

$75.00

Hospital Charge Code	22354922
Hospital Revenue Code	270
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Arizona Complete Health Allwell	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Devoted Health Medicare	$13.50
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Southwest Service Administrators UFCW	$51.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: United Healthcare Commercial	$42.90
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: Veterans Affairs TRICARE	$11.88

TRAY SUTURE REMOVAL SET

Facility

$8.00

Hospital Charge Code	22355579
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

TRAY SUTURE REMOVAL SET

Facility

$8.00

Hospital Charge Code	22355579
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

TRAY THORACENTESIS

Facility

$161.00

Hospital Charge Code	22354948
Hospital Revenue Code	270
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Arizona Complete Health Allwell	$25.76
Rate for Payer: Banner UC Health Medicare	$25.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$109.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.76
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cigna of AZ Commercial	$112.70
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Humana of AZ Medicare	$25.76
Rate for Payer: Southwest Service Administrators UFCW	$109.48
Rate for Payer: TriWest Medicare	$25.76
Rate for Payer: United Healthcare Commercial	$92.09
Rate for Payer: United Healthcare Medicare	$25.76
Rate for Payer: Veterans Affairs TRICARE	$25.50

TRAY THORACENTESIS

Facility

$161.00

Hospital Charge Code	22354948
Hospital Revenue Code	270
Min. Negotiated Rate	$144.90
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Cash Price	$128.80

TRAY TRACH CLEAN

Facility

$9.00

Hospital Charge Code	22355352
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

TRAY TRACH CLEAN

Facility

$9.00

Hospital Charge Code	22355352
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

TRAY UROLOGICAL 18F

Facility

$1,511.00

Hospital Charge Code	22354267
Hospital Revenue Code	270
Min. Negotiated Rate	$1,359.90
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Cash Price	$1,208.80

TRAY UROLOGICAL 18F

Facility

$1,511.00

Hospital Charge Code	22354267
Hospital Revenue Code	270
Min. Negotiated Rate	$239.34
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Arizona Complete Health Allwell	$241.76
Rate for Payer: Banner UC Health Medicare	$241.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,027.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$241.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$241.76
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cigna of AZ Commercial	$1,057.70
Rate for Payer: Devoted Health Medicare	$271.98
Rate for Payer: Humana of AZ Medicare	$241.76
Rate for Payer: Southwest Service Administrators UFCW	$1,027.48
Rate for Payer: TriWest Medicare	$241.76
Rate for Payer: United Healthcare Commercial	$864.29
Rate for Payer: United Healthcare Medicare	$241.76
Rate for Payer: Veterans Affairs TRICARE	$239.34

traZODone 100 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 904686961
Hospital Charge Code	105944266
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.12
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

traZODone 100 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 904686961
Hospital Charge Code	105944266
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Cash Price	$0.13

triamcinolone 0.1% Top Crm 30Gm [CQCH]

Facility

$0.21

Service Code	NDC 603786278
Hospital Charge Code	105944407
Hospital Revenue Code	251
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Cash Price	$0.17

triamcinolone 0.1% Top Crm 30Gm [CQCH]

Facility

$0.21

Service Code	NDC 603786278
Hospital Charge Code	105944407
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.12
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

triamcinolone acetonide 40 mg/1 mL IM Inj [CQCH]

Facility

$6.89

Service Code	HCPCS J3300
Hospital Charge Code	105944336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$27.83
Rate for Payer: Aetna of AZ Commercial	$6.20
Rate for Payer: Arizona Complete Health Allwell	$1.10
Rate for Payer: Banner UC Health Medicare	$1.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.10
Rate for Payer: Cash Price	$5.52
Rate for Payer: Cash Price	$5.52
Rate for Payer: Cigna of AZ Commercial	$4.48
Rate for Payer: Devoted Health Medicare	$1.24
Rate for Payer: Humana of AZ Medicare	$1.10
Rate for Payer: Seven Corners Travel Insurance	$27.83
Rate for Payer: Southwest Service Administrators UFCW	$4.69
Rate for Payer: TriWest Medicare	$1.10
Rate for Payer: United Healthcare Commercial	$3.94
Rate for Payer: United Healthcare Medicare	$1.10
Rate for Payer: Veterans Affairs TRICARE	$1.09

triamcinolone acetonide 40 mg/1 mL IM Inj [CQCH]

Facility

$6.89

Service Code	HCPCS J3300
Hospital Charge Code	105944336
Hospital Revenue Code	250
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna of AZ Commercial	$6.20
Rate for Payer: Cash Price	$5.52

TRI FLOW RESP

Facility

$26.00

Hospital Charge Code	22355210
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

TRI FLOW RESP

Facility

$26.00

Hospital Charge Code	22355210
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

TRIGGER POINT INJECTION

Facility

$227.00

Hospital Charge Code	22282950
Hospital Revenue Code	450
Min. Negotiated Rate	$35.96
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Arizona Complete Health Allwell	$36.32
Rate for Payer: Banner UC Health Medicare	$36.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$154.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.32
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cigna of AZ Commercial	$158.90
Rate for Payer: Devoted Health Medicare	$40.86
Rate for Payer: Humana of AZ Medicare	$36.32
Rate for Payer: Southwest Service Administrators UFCW	$154.36
Rate for Payer: TriWest Medicare	$36.32
Rate for Payer: United Healthcare Commercial	$129.84
Rate for Payer: United Healthcare Medicare	$36.32
Rate for Payer: United Healthcare New Mexico Commercial	$43.13
Rate for Payer: Veterans Affairs TRICARE	$35.96

TRIGGER POINT INJECTION

Facility

$227.00

Hospital Charge Code	22282950
Hospital Revenue Code	450
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Cash Price	$181.60

Know your out-of-pocket cost for care.

All Charges